CMAJ：焦虑或抑郁可能会引发中风

据最新一项研究证实：患有焦虑、抑郁、失眠或其他形式的心理困扰的人其中风死亡的风险也更大。

伦敦大学学院研究人员指出：心理问题困扰影响到总人口的15％至20％左右。以往的研究发现这些常见的精神疾病状态与冠状动脉疾病有关联，但尚未确定精神疾病与中风和其他心血管疾病之间的关联。

研究人员收集了参加英格兰健康调查研究的68,652名成年人信息。参试者绝大多数是白人，45％为男性，平均年龄约为55。

近15％的人称他们受到的心理问题困扰，这些有心里疾病的人大部分是妇女。那些有心理问题困扰的人更多时候是年轻人、吸烟者或是服用高血压治疗药物的人。他们收入往往也较低。

通过平均8年的追访研究，研究人员发现其中有2367人因缺血性心脏病的动脉阻塞、中风或其他心血管疾病死亡。

这项研究发表在6月18日的CMAJ杂志上。

研究人员得出结论称，问卷形式的诊断方式可以帮助医生更好诊断出常见的精神疾病患者，可以减少心脏疾病和中风死亡的风险。

doi:10.1503/cmaj.111719
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Psychological distress as a risk factor for death from cerebrovascular disease

Mark Hamer, Mika Kivimaki, Emmanuel Stamatakis, G. David Batty

Background: Little is known about psychological risk factors in cerebrovascular disease. We examined the association between psychological distress and risk of death due to cerebrovascular disease.

Methods: We obtained data from 68 652 adult participants of the Health Survey for England (mean age 54.9 [standard deviation 13.9] yr, 45.0% male sex) with no known history of cardiovascular diseases at baseline. We used the 12-item General Health Questionnaire (GHQ-12) to assess the presence of psychological distress. We followed participants for eight years for cause-specific death using linkage to national registers.

Results: There were 2367 deaths due to cardiovascular disease during follow-up. Relative to participants with no symptoms of psychological distress (GHQ-12 score 0) at baseline, people with psychological disress (GHQ-12 score ≥ 4, 14.7% of participants) had an increased risk of death from cerebrovascular disease (adjusted hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.32–2.08) and ischemic heart disease (adjusted HR 1.59, 95% CI 1.34–1.88). There was also evidence of a dose–response effect with increasing GHQ-12 score (p for trend < 0.001 in all analyses). Associations were only marginally attenuated after we adjusted for possible confounders, including socioeconomic status, smoking and use of antihypertensive medications.

Interpretation: Psychological distress was associated with increased risk of death due to cerebrovascular disease in a large populationrepresentative cohort. These data suggest that the cardiovascular effects of psychological distress are not limited to coronary artery disease.